(Circulation. 1995;91:2158-2166.)
© 1995 American Heart Association, Inc.
Articles |
One-Year Follow-up in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT I)
From the Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, Ohio (J.M.E., E.J.T.); Mayo Foundation, Rochester, NY (D.R.H.); St Elizabeth's Hospital, Boston, Mass (J.M.I., M.K.); Emory University School of Medicine, Atlanta, Ga (S.B.K.); and Duke Medical Center (L.G.B., G.P.K., R.M.C.), Durham, NC, and CAVEAT sites.
Correspondence to Eric Topol, MD, Department of Cardiology, F25, the Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.
Background Directional atherectomy is a frequently used percutaneous revascularization strategy, but its long-term outcomes have not previously been compared with those of balloon angioplasty in a prospective trial.
Methods and Results The 1012 patients enrolled in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT I) were followed for at least 1 year after randomization. Analyses of predetermined end points were performed, including a detailed analysis of the 14 patients who died. At 1 year, 11 patients had died in the atherectomy group compared with 3 in the angioplasty group (2.2% versus 0.6%, P=.035), with an excess of out-of-hospital deaths (2.2% versus 0.2%, P=.01) and late cardiac deaths (1.6% versus 0%, P=.01). Univariate predictors of death included age, abrupt closure, periprocedural enzyme elevation, and peripheral vascular complications. There was no evidence that the excess of deaths after atherectomy was linked to perforation, ectasia, or deep resection. Cumulative rates of myocardial infarction were higher in those who had been randomized to atherectomy than in those randomized to angioplasty (8.9% versus 4.4%, P=.005) with a trend toward excess Q-wave and non–Q-wave infarctions. By multivariate analysis, atherectomy was the only variable predictive of the combined end point of death or myocardial infarction. No clinical or angiographic characteristics added to this index. Rates of repeat percutaneous intervention at the target site (24.4% after atherectomy versus 25.9% after angioplasty), coronary artery bypass surgery (9.3% versus 9.1%), hospitalization (50% versus 47.1%), and stroke (1% in both groups) were not significantly different.
Conclusions Long-term follow-up of the 1012 patients randomized to atherectomy or angioplasty has revealed a statistically significant excess of deaths after directional atherectomy that was not evident at 6 months. This difference could be due to the chance occurrence of a low mortality rate in those randomized to angioplasty. The excess of myocardial infarctions after atherectomy remains statistically significant at 1 year. Further investigation is warranted to improve the safety of atherectomy.
Key Words: angioplasty • balloon • mortality • revascularization
This article has been cited by other articles:
 |
|
 |
|
  L. T. Newsome, M. A. Kutcher, and R. L. Royster Coronary Artery Stents: Part I. Evolution of Percutaneous Coronary Intervention Anesth. Analg., August 1, 2008; 107(2): 552 - 569. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Bhatt and E. J. Topol Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes Circulation, August 9, 2005; 112(6): 906 - 922. [Full Text] [PDF]
|
|
|
|
|
|
D. E. Cutlip and R. E. Kuntz Cardiac Enzyme Elevation After Successful Percutaneous Coronary Intervention Is Not an Independent Predictor of Adverse Outcomes Circulation, August 9, 2005; 112(6): 916 - 923. [Full Text] [PDF]
|
|
|
|
|
|
A. Angelini, P. Rubartelli, F. Mistrorigo, M. Della Barbera, F. Abbadessa, M. Vischi, G. Thiene, and S. Chierchia Distal Protection With a Filter Device During Coronary Stenting in Patients With Stable and Unstable Angina Circulation, August 3, 2004; 110(5): 515 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Bittl, D. P. Chew, E. J. Topol, D. F. Kong, and R. M. Califf Meta-Analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty J. Am. Coll. Cardiol., March 17, 2004; 43(6): 936 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Bhargava, G. Karthikeyan, A. S Abizaid, and R. Mehran New approaches to preventing restenosis BMJ, July 31, 2003; 327(7409): 274 - 279. [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Willerson Myocardial Revascularization with Cardiologic Interventional Devices Card. Surg. Adult, January 1, 2003; 2(2003): 561 - 580. [Full Text]
|
|
|
|
|
|
M. J. Quinn, E. F. Plow, and E. J. Topol Platelet Glycoprotein IIb/IIIa Inhibitors: Recognition of a Two-Edged Sword? Circulation, July 16, 2002; 106(3): 379 - 385. [Full Text] [PDF]
|
|
|
|
|
|
J. F. Saucedo, R. Mehran, G. Dangas, M. K. Hong, A. Lansky, K. M. Kent, L. F. Satler, A. D. Pichard, G. W. Stone, and M. B. Leon Long-term clinical events following creatine kinase-myocardial band isoenzyme elevation after successful coronary stenting J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1134 - 1141. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Topol and J. S. Yadav Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease Circulation, February 8, 2000; 101(5): 570 - 580. [Full Text] [PDF]
|
|
|
|
|
|
A. Kini, J. D. Marmur, S. Kini, G. Dangas, T. P. Cocke, S. Wallenstein, E. Brown, J. A. Ambrose, and S. K. Sharma Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course: Implications for early discharge after coronary intervention J. Am. Coll. Cardiol., September 1, 1999; 34(3): 663 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Zenati, H. A. Cohen, and B. P. Griffith ALTERNATIVE APPROACH TO MULTIVESSEL CORONARY DISEASE WITH INTEGRATED CORONARY REVASCULARIZATION J. Thorac. Cardiovasc. Surg., March 1, 1999; 117(3): 439 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. N. Piana, W. H. Ahmed, B. Chaitman, P. Ganz, S. Kinlay, J. Strony, B. Adelman, J. A. Bittl, and on behalf of the Hirulog Angioplasty Study Investi Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months J. Am. Coll. Cardiol., January 1, 1999; 33(1): 73 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bramucci, L. Angoli, P. A. Merlini, P. Barberis, M. L. Laudisa, E. Colombi, A. Poli, J. Kubica, and D. Ardissino Adjunctive stent implantation following directional coronary atherectomy in patients with coronary artery disease J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1855 - 1860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The PURSUIT Trial Investigators Inhibition of Platelet Glycoprotein IIb/IIIa with Eptifibatide in Patients with Acute Coronary Syndromes N. Engl. J. Med., August 13, 1998; 339(7): 436 - 443. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Narins, D. R. Holmes Jr, and E. J. Topol A Call for Provisional Stenting : The Balloon Is Back! Circulation, April 7, 1998; 97(13): 1298 - 1305. [Full Text] [PDF]
|
|
|
|
|
|
D. O. Williams and M. C. Fahrenbach Directional Coronary Atherectomy : But Wait, There's More Circulation, February 3, 1998; 97(4): 309 - 311. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Baim, D. E. Cutlip, S. K. Sharma, K. K. L. Ho, R. Fortuna, T. L. Schreiber, R. L. Feldman, J. Shani, C. Senerchia, Y. Zhang, et al. Final Results of the Balloon vs Optimal Atherectomy Trial (BOAT) Circulation, February 3, 1998; 97(4): 322 - 331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Simonton, M. B. Leon, D. S. Baim, T. Hinohara, K. M. Kent, R. M. Bersin, B. H. Wilson, G. S. Mintz, P. J. Fitzgerald, P. G. Yock, et al. `Optimal' Directional Coronary Atherectomy : Final Results of the Optimal Atherectomy Restenosis Study (OARS) Circulation, February 3, 1998; 97(4): 332 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Topol, R. M. Califf, F. Van de Werf, M. Simoons, J. Hampton, K. L. Lee, H. White, J. Simes, and P. W. Armstrong Perspectives on Large-Scale Cardiovascular Clinical Trials for the New Millennium Circulation, February 18, 1997; 95(4): 1072 - 1082. [Full Text]
|
|
|
|
|
|
J. A. Bittl Advances in Coronary Angioplasty N. Engl. J. Med., October 24, 1996; 335(17): 1290 - 1302. [Full Text] [PDF]
|
|
|
|
|
|
T. Kimura, H. Yokoi, Y. Nakagawa, T. Tamura, S. Kaburagi, Y. Sawada, Y. Sato, H. Yokoi, N. Hamasaki, H. Nosaka, et al. Three-Year Follow-Up after Implantation of Metallic Coronary-Artery Stents N. Engl. J. Med., February 29, 1996; 334(9): 561 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Topol and S. E. Nissen Our Preoccupation With Coronary Luminology : The Dissociation Between Clinical and Angiographic Findings in Ischemic Heart Disease Circulation, October 15, 1995; 92(8): 2333 - 2342. [Abstract] [Full Text]
|
|
|
|
 |
|
 . . . or Native Lesions Journal Watch Cardiology, June 1, 1995; 1995(601): 4 - 4. [Full Text]
|
|